NURSING ETHICS TEST BANK

NURSING ETHICS TEST BANK ____________________ is the duty to do or promote good. - ANSWER -Beneficence ____________________ refer to private, personal, or group standards of right and wrong. - ANSWER -Morals .____________________ refers to the application of ethical principles to healthcare. - ANSWER -Bioethics A 45-year-old patient is ventilator dependent after a high cervical neck injury. He is alert and oriented and, after giving it much thought, has decided that he wants to be removed from the ventilator. The nurse believes the patient intends suicide but supports his final decision. When the ventilator is removed, the nurse remains with the patient to support him. The nurses action demonstrates respect for what moral principle? 1) Nonmaleficence 2) Autonomy 3) Beneficence 4) Fidelity - ANSWER -2) Autonomy Autonomy refers to a persons right to choose and his ability to act on that choice. In this case, the nurse respects the patients right to choose to die. Nonmaleficence is the twofold principle of doing no harm and preventing harm. Beneficence is the duty to do or promote good. Fidelity is the obligation to keep promises. A 45-year-old patient is ventilator dependent after a high cervical neck injury. He is conscious and competent and has decided that he wants to be removed from the ventilator. His family and the multidisciplinary team agree. The nurse believes the patient intends suicide and would prefer he choose differently but says nothing. The nurse remains at the bedside holding the patients hand. In this instance the nurse is displaying which of the following? 1) Value set 2) Value system 3) Value neutrality 4) Value awareness - ANSWER -3) Value neutrality Value neutrality occurs when we put aside our own values regarding an issue in order to provide nonjudgmental care to clients. A value set is your list of values. A value system is your value set with the values ranked on a continuum from most important to least important. A 60-year-old patient with a treatable form of breast cancer has decided not to pursue radiation or chemotherapy. The nurse believes that the patient should be treated. She coerces her into receiving treatment by continuing to remind the patient about her responsibilities for raising her children. What type of behavior has the nurse displayed? 1) Nonmaleficence 2) Autonomy 3) Paternalism 4) Beneficence - ANSWER -3) Paternalism Paternalistic behavior occurs when the nurse thinks she knows what is best for a competent patient and coerces the patient to act as she wishes rather than to act as the patient originally desired. Autonomy refers to a persons right to choose and his ability to act on that choice. Nonmaleficence is the twofold principle of doing no harm and preventing harm. Beneficence is the duty to do or promote good. A 77-year-old woman with an inoperable brain tumor has been hospitalized for the past 5 days. Her daughter comes to visit her. The patient has asked that her daughter not be told her diagnosis. After visiting with her mother, the daughter asks to speak to the nurse. She says, My mother claims she has pneumonia, but I know she is not telling me the truth. The daughter asks the nurse to tell her what is truly wrong with her mother. The nurse should tell her that: 1) Her mother has an inoperable brain tumor, but does not wish anyone to know. 2) She needs to speak to the physician in charge of her mothers care. 3) Her mother has requested that her case not be discussed with anyone, not even family. 4) Her mother is very sick with a serious case of pneumonia that could lead to death. - ANSWER -3) Her mother has requested that her case not be discussed with anyone, not even family. The nurses first allegiance is to the patient and her desire for confidentiality. Telling the daughter to speak to the physician would place the physician in the same position as the nurse. Telling her that her mother has pneumonia would be a lie. The nurse, of course, should inform the physician of the patients wishes so that he will be prepared if the daughter questions him about her mothers health condition. A belief about the worth of something that serves as a principle or a standard that influences decision making is called which of the following? 1) Morals 2) Attitudes 3) Beliefs 4) Values - ANSWER -4) Values A value is a belief you have about the worth of something that serves as a principle or a standard that influences decision making. Morals are private, personal, or group standards of right and wrong. Attitudes are mental dispositions or feelings toward a person, object, or idea. A belief is something that one accepts as true. A client is asking about developing a living will. What act protects this right? Americans With Disabilities Act Emergency Medical Treatment and Active Labor Act Patient Self-Determination Act Health Insurance Portability and Accountability Act - ANSWER -Patient Self-Determination Act A name-brand ice cream contains the following nutrition information for each serving: 30 g carbohydrates, 19 g fat, 5 g protein. The total number of calories in a serving would be A. 366 B. 311 C. 435 D. 176 - ANSWER -B. 311 CHO = 4 cal per gram = 120 cal Fat = 9 cal per gram = 171 cal Protein = 4 cal per gram = 20 cal Total: 311 cal A patient has asked the nurse to explain her laboratory results. The nurse informs the patient that he must first assist another patient to the bathroom and then he will explain the results. The nurse assists the other patient to the bathroom and then returns to explain the results to the patient. What moral principle has the nurse displayed? 1) Nonmaleficence 2) Autonomy 3) Beneficence 4) Fidelity - ANSWER -4) Fidelity Fidelity is the obligation to keep promises. Autonomy refers to a persons right to choose and his ability to act on that choice. Nonmaleficence is the twofold principle of doing no harm and preventing harm. Beneficence is the duty to do or promote good. An alert, oriented, and competent frail older adult man has been told that he is dying and has asked to have a DNAR order put on his chart. The patients family does not agree with his decision and asks the healthcare team to ignore the request. After a great deal of discussion among the physician, nurse, and family, they are no closer to resolution of the conflict. The nurse asks the hospital chaplain to come and help the family and the team understand each others opposing views. Which step of the MORAL model does this illustrate? 1) Massage the dilemma 2) OOutline the options 3) Resolve the dilemma 4) Look back and evaluate - ANSWER -2) OOutline the options This illustrates the Outlining-options step. In Massaging the dilemma, the team would already have identified and defined the issues in the dilemma, and considered the values and options of all the major players. At the Outlining the options step, someone should delineate all of the options to all parties, including those that are less realistic and conflicting. In that step, someone often asks a member of the ethics committee or the hospital chaplain to help the parties understand the opposing viewpoints. Resolving the dilemma is the step in which all the options are reviewed and basic moral principles and frameworks are applied to arrive at a decision. Looking back to evaluate is done after a decision has been made and acted on. At that time, the entire process, including the consequences, is evaluated to determine how well it worked. An alert, oriented, and competent frail older adult man has been told that he is dying, and has asked to have a DNAR order put on his chart. The patients family does not agree with his decision and asks the healthcare team to ignore the request. The healthcare team does not comply with the familys wishes, and after several days the family takes the matter to court. The court sides with the family and orders the healthcare team to remove the DNAR order. This is an example of which of the following? 1) An integrity-producing (good) compromise 2) An ethically sound compromise 3) Settlement of an issue by force 4) An effort to keep peace on the unit - ANSWER -3) Settlement of an issue by force This is clearly an example of settling an issue by force, bringing in a more powerful entity (the court) to force the healthcare team to do what the family wants. It is not a compromiseof any sortbecause neither party backed away from its original position, and the action that was taken was not agreed on by both parties. This was not an effort to keep peace. The familys effort was to settle the disagreement in their favor. If the healthcare teams goal had been to keep peace on the unit, they would have acceded to the familys wishes without the need for court order. Identify one or more choices that best complete the statement or answer the question. ____ 1. Which of the following is an example of whistle-blowing? Choose all that apply. 1) Reporting fraudulent billing practices 2) Reporting patients health status against the patients wishes 3) Reporting unsafe work practices 4) Reporting a coworker for working under the influence of drugs - ANSWER -1) Reporting fraudulent billing practices 3) Reporting unsafe work practices 4) Reporting a coworker for working under the influence of drugs Reporting a patients health status against the patients wishes is a breach of patient confidentiality. Whistle-blowing is identifying incompetent, unethical, or illegal situations or actions of others in the workplace and reporting to someone who may be in a position to rectify the situation. Fraudulent billing practices are illegal and unethical; unsafe work practices are unethical and illegal; and a coworker under the influence of drugs is a risk to patients, as well acting in an illegal and unethical manner. Identify the client with the greatest risk for developing protein-calorie malnutrition. A.A client who has multiple sclerosis and is in a wheelchair B.A client weighing 300 lb who has entered the hospital for cardiac bypass surgery C.A client with a broken arm and femur from trauma who is running a fever of 101.5°F (38.6°C) D.A client who is of Native American heritage - ANSWER -C.A client with a broken arm and femur from trauma who is running a fever of 101.5°F (38.6°C) This client would have the greatest increase in metabolic demand for "energy"/nutrients and runs the greatest risk for not having those energy demands met. Fever increases energy needs. 7 kcal per degree maybe Identify the third step in the MORAL decision-making model. 1) Reassess the dilemma 2) Resolve the dilemma 3) Review the problem 4) Recall the history of the problem - ANSWER -2) Resolve the dilemma MORAL is an acronym - ANSWER -M, Massage the dilemma; O, Outline the options; R, Resolve the dilemma; A, Act by applying the chosen option; L, Look back and evaluate. Nursing codes are: 1) Legally binding. 2) Not legally binding. 3) Legally binding in some circumstances. 4) Not admissible in court. - ANSWER -2) Not legally binding. Codes of ethics are open to public scrutiny. The ethical aspects of nursing work, just like the technical aspects, are subject to review by professional groups and licensure boards, which may use sanctions to punish code violations. However, nursing codes are not legally binding. The ability of nurses to base their practice on professional standards of ethical conduct and to participate in ethical decision making is known as which of the following? 1) Ethical agency 2) Attitudes 3) Belief 4) Value neutrality - ANSWER -1) Ethical agency Ethical agency is the ability of nurses to base their practice on professional standards of ethical conduct and to participate in ethical decision making. Attitudes are mental dispositions or feelings toward a person, object, or idea. A belief is something that one accepts as true. Value neutrality is when we attempt to understand our own values regarding an issue and to know when to put them aside, if necessary, to become nonjudgmental when providing care to clients. The nurse is a member of the ethics committee. An alert, oriented, and competent 87-year-old man has asked to have a DNAR order put on his chart. The patients family does not agree with his decision and requests the ethics committee to intervene on their behalf. The ethics committee would most likely use which model in this patients case? 1) Social justice 2) Patient benefit 3) Autonomy 4) DNAR determination - ANSWER -3) Autonomy The autonomy model is useful when the patient is competent to decide. This model emphasizes patient autonomy and choice as the highest values. The patient benefit model assists in decision making for the incompetent patient by using substituted judgment. The social justice model focuses more on broad social issues involving the entire institution rather than on a single patient issue. There is no DNAR determination model. The nurse is explaining the Health Insurance Portability and Accountability Act to a group of new employees. What should the nurse include when explaining its purpose? Select all that apply. Protects health insurance benefits Provides transferability of insurance to others Protects family members Protects those with preexisting conditions Provides personal health information privacy - ANSWER -Protects family members Protects those with preexisting conditions Provides personal health information privacy The nurse is teaching a patient about the importance of reducing saturated fats in a cardiac diet. Which oils should the nurse recommend as options? Select all that apply. Palm oil Coconut oil Cottonseed oil Peanut oil Olive oil - ANSWER -Palm oil Cottonseed oil Olive oil The nurse knows that a provider with type 1 diabetes became hypoglycemic while performing a bedside thoracentesis. The provider resisted assistance and finished the procedure despite being impaired. The nurse is upset by the provider's behavior. This is an example of nursing ethics. A.True B.False - ANSWER -Both? A &B (Both): This example most directly involves the ethical behavior of the provider, so you might think it is not nursing ethics; however, it could be argued that the nurse has a duty to report impaired practice. The nurse performs care on an unconscious person at the grocery store. What law protects the nurse in this situation? Medical Treatment and Active Labor Act American Nurses Association Code of Ethics Good Samaritan laws Nurse practice acts - ANSWER -Good Samaritan laws The nurse was just hired to work in a hospice day care facility. She reflects on her ethical framework and decides that she believes in establishing relationships with an emphasis on caring. Which frameworks can the nurse use? Select all that apply. A.Deontology B.Feminist ethics C.Utilitarianism D.Ethics of care - ANSWER -B.Feminist ethics D.Ethics of care B&D: •An ethics of care philosophy incorporates understanding the story of the person's life. It naturally incorporates care, which is viewed as a responsibility, as opposed to an obligation. It also focuses on the client's autonomy and promotes beneficence. •A feminist ethics reasoning uses relationships and stories rather than universal principles. Feminists argue that relationships are positive and they use stories rather than universal principles. •The theory of deontology focuses on "Doing." It is based on following the rules and regulations. Good is defined as adherence to guidelines and directives. •The theory of utilitarianism focuses on "Thinking." It considers the best course of action which has the best outcome for the greatest number. This requires one to engage in a risk-benefit analysis to decide the best course of action. The nurses obligations in ethical decisions include which of the following? Choose all that apply. 1) Be a patient advocate. 2) Involve institutional ethics committees. 3) Improve ones own ethical decision making. 4) Respect patient confidentiality. - ANSWER -1) Be a patient advocate. 2) Involve institutional ethics committees. 3) Improve ones own ethical decision making. 4) Respect patient confidentiality. The nurses obligations in ethical decisions include being a patient advocate, using and participating in institutional ethics committees, and improving ethical decision making. Confidentiality is a basic patient right. The nurses role is to uphold that right. To promote wound healing, the nurse is teaching a patient about choosing foods containing protein. Which foods are incomplete proteins that should be consumed with a complementary protein? Select all that apply. Whole grain bread Peanut butter Turkey Cheese Refried beans - ANSWER -Whole grain bread Peanut butter Refried beans Using the MORAL acronym for making an ethical decision, under which "letter" would the following action fall? The physician explains to the laboring woman the impact on the unborn child of refusing a cesarean birth. A.M B.L C.R D.O - ANSWER -D. O The letter "O" in the MORAL acronym represents the step of outlining options. The physician would explain to the patient all of the consequences and options of either having or not having the C-section, and listen to the patient for her viewpoint. What are the parts of a comprehensive nutritional assessment? Select all that apply. Body composition Physical assessment Laboratory findings Body surface area Dietary history - ANSWER -Body composition Physical assessment Dietary history Which is the correct formula for calculating body mass index? Weight in pounds ÷ (height in inches)2 Weight in pounds ÷ (height in meters)2 Weight in kg ÷ (height in meters)2 Weight in kg ÷ (height in inches)2 - ANSWER -Weight in kg ÷ (height in meters)2 Which objective measures can a nurse use to assess a person's dietary history. Select all that apply. A. Measure body composition B. Ask about diet C. 3-day food record diary D. Food questionnaire E. 24-hour memory recall - ANSWER -C. 3-day food record diary D. Food questionnaire E. 24-hour memory recall Which of the following consequentialist theories takes the position that the value of an action is determined by its usefulness? 1) Ethics of care 2) Utilitarianism 3) Deontology 4) Categorical imperative - ANSWER -2) Utilitarianism Utilitarianism is a consequentialist theory that takes the position that the value of an action is determined by its usefulness. An ethics of care is a nursing philosophy that directs attention to the specific situations of individual patients viewed within the context of their life narrative. Deontology considers an action to be right or wrong independent of its consequences. A categorical imperative is a principle, established by Immanuel Kant, that states that one should act only if the action is based on a principle that is universal. Which of the following terms refers to the ethical questions that arise out of nursing practice? 1) Nursing ethics 2) Bioethics 3) Ethical dilemma 4) Moral distress - ANSWER -1) Nursing ethics Nursing ethics refers to ethical questions that arise out of nursing practice. Bioethics is a broader field that refers to the application of ethics to healthcare. An ethical dilemma occurs when a choice must be made between two equally undesirable actions, and there is no clearly right or wrong option. Moral distress occurs when someone is unable to carry out his or her moral decision.